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Affordable Care Act: It Depends on Where You Live

March 30, 2014

Plain English Version

Friend and foe said the Affordable Care Act (Obamacare) is national health insurance. Conservatives do not like it. They said health insurance is not the federal government’s business. Progressives say it is time for everyone to get health insurance.

Experts now say the one thing the program is not is “national.” It all depends in which state you live.

States like Connecticut set up health exchanges to help people get insurance.

States like Texas did not. People had to rely on the poorly managed national Web site. And a state government that is not working actively to remove bureaucratic barriers.

States could also choose not to join an expanded Medicaid program. Missouri is an example. Some Missourians earn too much for the old Medicaid program and too little for the new program of subsidized health insurance. They are out in the cold.

Kentucky expanded Medicaid. Eighty percent of those who are newly enrolled for health insurance entered through Medicaid.

The Affordable Care Act is national legislation. But, for health care coverage, it is better to be lower-income in Kentucky than to be lower-income in Missouri.

Experts say there is no way to tell if the Affordable Care Act is working right now. The number of enrollees means very little. What kind of insurance are they getting? How much are they paying in premiums? How well are the health insurance companies managing the program?

For now, individuals have their stories. Still, the state where you live does matter.